Department of Physical Therapy Student Theses, Dissertations and Capstones

Document Type

Dissertation - NSU Access Only

Degree Name

Doctor of Philosophy (PhD) in Physical Therapy

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.

First Advisor

Alicia Fernandez-Fernandez

Date of original Performance / Presentation

January 2026

Publication Date / Copyright Date

1-1-2026

Abstract

Background Frailty and disability are commonly associated domains affecting stroke outcomes. However, evidence is scarce on the existence of diverse frailty and functional trajectories among elderly stroke survivors aged ≥ 65 years and long-term outcomes of rehabilitation programs post-stroke. Objective Our study aimed to assess long-term frailty and functional trajectories, rehabilitation outcomes, and their determinants in community-dwelling elderly stroke survivors in the US. Methods Our study was a secondary analysis of the NHATS data from 2011 to 2023. Data were recorded at baseline and followed for 3 years. Latent class mixed models and group-based trajectory models were used to analyze frailty and functional trajectories, respectively. Multivariate logistic regression was used to identify predictors for the trajectories and rehabilitation outcomes. Results Three distinct frailty trajectories were identified: the higher frailty trajectory, comprising 545 participants (65.8%), followed by the very low frailty group with 150 participants (18.1%) and the moderate frailty group with 133 participants (16.1%). Five diverse functional trajectories were identified, with 30% of participants belonging to the persistently severe impairment group, 24% to the mild decline group, 18% and 20% to the low and moderate decline groups, and 7% being functionally stable throughout follow-up. Advanced age, diabetes, cognitive impairment, and poor self-rated health were the common independent predictors of worse frailty and functional trajectories. Dementia was a predictor of higher frailty but not poor function. Frail elderly stroke survivors, Hispanics, and those with diabetes and heart attack had higher odds of not meeting their rehabilitation goals. Rehabilitation duration, education, and heart disease emerged as key predictors of functional improvement during rehabilitation. Insurance exhaustion was not associated with any factors. Conclusion Diverse frailty and functional trajectories among elderly stroke survivors are driven by demographic characteristics along with cognitive function, perceived health status, and associated metabolic conditions. Frailty, education, rehabilitation duration, and associated comorbidities influence long-term rehabilitation outcomes. Personalized care pathways incorporating frailty and functional assessments and proactive management of diabetes and cognitive, social, and mental health may improve recovery among elderly stroke survivors.

Disciplines

Physical Therapy

Keywords

Frailty trajectories; Functional trajectories; NHATS; Older adults; Rehabilitation outcomes; Stroke survivors

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